Provider Demographics
NPI:1215494463
Name:FIRST PEEK ULTRASOUND
Entity type:Organization
Organization Name:FIRST PEEK ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BEEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOLJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-215-8703
Mailing Address - Street 1:7121A NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1002
Mailing Address - Country:US
Mailing Address - Phone:972-215-8703
Mailing Address - Fax:
Practice Address - Street 1:7121A NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1002
Practice Address - Country:US
Practice Address - Phone:972-215-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty